Specific embodiment
Certain exemplary embodiments will now be described, to understand the knot of apparatus and method as disclosed herein on the wholeStructure, function, manufacture and purposes.One or more examples of these embodiments are shown in the accompanying drawings.Those skilled in the art willUnderstand, the device and method for specifically describing and being shown in the accompanying drawings herein are non-limited exemplary embodiment and the present inventionRange be limited only by the appended claims.With regard to the feature that an exemplary embodiment is illustrated or described, can with it is otherThe feature of embodiment is combined.It is intended to be included within the scope of the present invention for this modification and version.Therefore,For one exemplary embodiment of surgical implant managing device includes special characteristic structure, those skilled in the art willIt is enough that this feature structure is incorporated in other surgical implant managing devices, the various implementations including being incorporated herein provided deviceIn example, and it is incorporated to known to those skilled in the art for managing in other devices of implantation material etc..
In the disclosure, the identical component of the number of embodiment usually has similar feature and/or purpose.In addition, justUsing linearly or for circular dimension in the description of disclosed systems, devices and methods, such size, which is not intended to limit, to be tiedClose the type for the shape that such systems, devices and methods use.It will be understood by those skilled in the art that for any geometric formShape can easily determine out the equivalent size of these linear dimensions or circular dimension.It implantation material managing device and is associated with itComponent size and shape can depend, at least partially, on will use implantation material subject anatomical structure, will be with implantation materialThe size and shape for the component that managing device is used together, and the method and operation that the system and device will be used.With regard to featureStructure is described herein as " fisrt feature structure " or " second feature structure ", and such numerical order is usually any, and thus such number is interchangeable.
Attached drawing provided herein is not necessarily drawn to scale.In addition, just being described using arrow securable or drawing partFor direction, these arrows are exemplary, and are in no way intended to limit the direction that all parts can be tensioned or pull.This fieldTechnical staff other way and direction for generating desired tension or movement will be recognized.Similarly, although someIn embodiment, the movement of another component is described relative to a component, those skilled in the art will recognize that, Qi TayiDynamic is also possible.In addition, many terms can be interchangeably used in the disclosure, but those skilled in the art willUnderstand.By way of non-limiting example, term " suture " and " silk " are used interchangeably and " flexure " and " folding "It is used interchangeably.
The present disclosure relates generally to for selectively keeping the surgical implant management of surgical implant or other constructions to fillIt sets.The managing device can be not only used for the component that implantation material is kept before implantation material is used for surgical operation, it can also be used to helpPrepare surgical operation, this is at least partly due to a part as device and some feature structures for providing.For example, as followsText is described in further detail, which may include allowing user easily in device, implantation material and/or associated therewith toughWith the feature structure for marking specific range on graft, to help user preferably to know implantation material and implantation of ligament object outsideThe perioperative position of section.The device may include feature structure in combination, and the measurement markers such as on apparatus surface makeOther device (for example, scale) must not needed to measure specific distance or length.In addition, various configurations provided herein canIt makes it easier to avoid the various silks of implantation material to tangle more easily to recognize silk, and in general, may make more easilyUsing implantation material and execute operation associated therewith.
Surgical implant
Although disclosure provided herein is used in combination with a variety of implantation materials, shown in Figure 1A and Figure 1B two it is non-Limitative examples embodiment.Each of implantation material 10,10' generally include associated with one or more implantableBody 12,12', wherein at least one silk form one or more adjustable coils or ring 14,14'.More particularly, Figure 1A showsImplantation material 10 is gone out comprising the main body 12 of formed therein which through-hole and the first suture filament 11 associated therewith.TheOne 11 (sometimes referred to as graft keeps suture) can be connected to main body 12 or in other words associated with main body 12, andIt is configured to keep the implantation of ligament object for implantation.In an illustrated embodiment, first 11 a part is formed by being arranged inThe multiple adjustable coils or ring 14, middle ring 14 that self-locking knot 13 on the top side 12t of main body 12 limits are mainly disposed toOn the bottom side 12b of body 12.Silk 11 may include that (as shown in the figure can at least one the adjustable branch extended from knot 13 or tail portionThe the first branch 15a and adjustable second branch 15b adjusted), and branch 15a, 15b can be operable to open to its applicationThe size of the one or more opening 14o formed by the one or more in ring 14 is adjusted when power.
Can be removably associated with main body 12 by one or more other silk, to help to control during surgeryImplantation material.As shown, second 16 (being sometimes referred to as shuttle suture or silk or guide's suture or silk herein) settingIn the through-hole of first end for being located at main body 12, and third silk 18 (is sometimes referred to as herein and trails or stir sutureOr silk) be arranged in main body 12 the second end through-hole in.This two silk 16,18 (being referred to as guide wire) can be used for helpingBy implantation material 10 and thus the implantation of ligament object positioning that would be associated with and required implantation position is set.Shown inIn embodiment, second 16 first branch 16a and the second branch 16b extends from the opposite side of a through-hole, and theThree 18 first branch 18a and the second branch 18b extend from the opposite side of another through-hole.
In addition, in some exemplary embodiments, each branch 16a, 16b may include being configured to receive adjustableReceiving portion 17a, 17b of the corresponding portion of one branch 15a and adjustable second branch 15b.Branch 15a, 15b setting are existedIt can help to fiber tube reason in receiving portion 17a, 17b, and provide convenient mode to assist in ensuring that adjustable first can divideAny cutting of branch 15a and adjustable second branch 15b will not damage the integrality of self-locking knot 13.More particularly, branchThe integrality that a part in receiving portion 17a, 17b could be trimmed to about and still maintain knot 13 is arranged in 15a, 15b.The skill of this fieldFor art personnel it will be recognized that when too close main body 12 cuts branch 15a, 15b, the integrality of knot 13 will receive damage, and becauseAnd the intensity of implantation material 10 will receive damage.About the further details of the implantation material with property shown in Figure 1A, in 2013Entitled " the Implant Having Filament Limbs of an Adjustable Loop submitted December 11It is provided in the U.S. Patent Application Serial Number 14/103,167 of Disposed in a Shuttle Suture ", the patentThe content of application is incorporated by herein by reference.
The implantation material of Figure 1B is the implantation material used in combination with implantation material managing device provided in this article and surgical methodAnother exemplary embodiment of 10'.As shown, implantation material 10' is similar to the implantation material 10 of Figure 1A, the difference is that its offerFor protecting the alternate configuration of the integrality of first knot.Similar to implantation material 10, implantation material 10' includes: to be formed whereinThere is the main body 12' of through-hole, is connected to main body 12' or otherwise first thread 11', Yi Jike associated with main body 12' is arrivedReleasably it is connected to second 16' and third silk 18' of the opposite through-hole of main body 12'.A part of first 11' can be formedBy the self-locking knot 13' being arranged on the top side 12t' of the main body 12' multiple adjustable coils limited or ring 14', middle ring 14'It is mainly disposed on the bottom side 12b' of main body 12'.Silk 11' may include at least one from the knot 13' adjustable branch extended orTail portion (adjustable first branch 15a' and adjustable second branch 15b' as shown in the figure), and branch 15a', 15b'It can be operable to adjust the one or more opening 14o''s formed by the one or more in ring 14' when applying tension to itSize.Second 16' and third silk 18' can be used as first seal wire and hangover silk, wherein the first branch 16a' of second 16' and theTwo branch 16b' extend from the opposite side of a through-hole, and the first branch 18a' and the second branch 18b' of third silk 18'Extend from the opposite side of another through-hole.
Different from the embodiment of Figure 1A, second 16' does not receive the part of adjustable branch 15a', 15b'.On the contrary, adjacentThe top surface of nearly main body 12' is on the top side 12t' of main body 12' in adjustable first branch 15a' and adjustable secondA part top setting casing or gasket 19' of branch 15b'.More particularly, as shown, casing 19' is to be formed whereinThere are multiple holes to receive the single stitch silk of adjustable first branch 15a' and adjustable second branch 15b'.Casing19' can be on the 12t' of top side around a part setting of the first branch 15a', and the bottom surface around main body 12' is wound, thenWraparound top side 12t', therefore it can be around a part setting of the second branch 12b'.Bottom surface around main body 12' winds setPipe 19' can help utmostly to reduce when tensing adjustable branch 15a', 15b' casing 19' to branch 15a', 15b'End 15t1'、15t2' nearside it is mobile.First end 15t1' can be in the first hole 19a' sleeve pipe 19' and in the second hole19b' is pierced by casing 19', and second end 15t2' can be pierced by third hole 19c' sleeve pipe 19' and in the 4th hole 19d'Casing 19'.Similar to the receiving portion 17 of implantation material 10, casing 19' can help to prevent the too close main body 12' of surgeon from cuttingCut branch 15a', 15b'.More particularly, about the embodiment, casing 19' usually can have resilient property so that itsGather when applying compressing force, then surgeon can cut branch 15a', 15b' in the position by adjacent pores 19b', 19d'.It closesIn the further details of the implantation material with property shown in Figure 1B, in the entitled " Implant that on March 11st, 2013 submitsIt is provided in the U.S. Patent Application Serial Number 13/793,514 of Having Adjustable Filament Coils ", it shouldThe content of patent application is incorporated by herein by reference.
A variety of other configurations of implantation material with property provided in this article and other types of implantation material are combinableDisclosure related with implantation material managing device and method provided herein uses.In a manner of non-limitative example, oneIn a little embodiments, one or more ring associated with implantation material main body be can be fixed, rather than adjustable, and prolong from itThe one or more branches stretched can be configured for other purposes in addition to adjusting ring size, and such purpose is the skill of this fieldKnown to art personnel.
Implantation material managing device
Fig. 2A and Fig. 2 B shows the one of surgical implant managing device 100 (being sometimes referred to as implantation material management card herein)A exemplary embodiment.Card 100 in unfolded state is shown in fig. 2, and in folded state card 100 configuration (It is sometimes referred to as compact configuration herein) it shows in fig. 2b.More particularly, Fig. 2 B is top side or top surface shown inThe result of the second part 128 of 112 lower section scored card 100, that is, towards the bottom side of card 100 or bottom surface 114 (Fig. 2 D) foldingIt is folded.This causes the label 136 (as shown in Figure 2 A) formed on second part 128 on the bottom side of card 100 114 as it can be seen that as schemedShown in 2D.In folding or compact configuration, second part 128 is especially the label 136 being formed on can be intentional for instituteBecome a part of bottom surface 114 with purpose.
Although the main body 102 of card 100 itself can have various shapes and configuration, some of shapes and configuration are at thisIt is shown in text, and many other shapes and configuration can be obtained based on the disclosure, in an illustrated embodiment, main body102 have by first end 104, the second end 106 and the opposite wall extended between the two described ends 104,106108, the 110 substantially rectangular in cross section shape limited.The device further includes top side or (sometimes referred to as the first side of top surface 112Or first surface) and bottom side or bottom surface 114 (sometimes referred to as second side or second surface).Central longitudinal axis L can edgeThe length of main body 102 extends, and can be located at the side 108 opposite with two, 110 positions generally equidistants.For ease of referring to,Central longitudinal axis L will be used in each embodiment as described herein, or even when the variation of other Ref. No.s.Main body 102 is logicalLength l, width w can be often defined as and thickness t (is not marked, but prolong between top surface 112 and bottom surface 114It stretches).According to the configuration of card 100, when card 100 is moved to folding configuration from deployed configuration, in length l, width w and thickness tAny one can change.
Although main body 102 is described as be in generally rectangular in shape, those skilled in the art be will be appreciated thatFirst end 104 and the second end 106 are perpendicular to the single straight of central longitudinal axis L unlike in typical rectangleLine.On the contrary, each end 104,106 is that point 104M, 106M is tapered thereto, thus forms symmetrical end.Institute as followsIt discusses, without departing from the spirit of the present disclosure, based in part on other feature structure, the shape and size of card,First end 104 and the second end 106 can have a variety of other shapes.In the exemplary embodiment, it is in deployed configuration durationSpending l can be about in the range of about 100 millimeter to about 250 millimeters, in folding configuration Shi Qike substantially at about 80 millimeters to aboutIn the range of 220 millimeters, in fold or when deployed configuration width w can substantially in the range of about 35 millimeters to about 80 millimeters,And thickness t can be substantially in the range of about 0.01 millimeter to about 1 millimeter, wherein when being in folding configuration when being in deployed configurationThe amount of folding of the thickness t based on generation and with each section of card change, such thickness change can be easily by the technology of this fieldPersonnel determine.Length l when in one exemplary embodiment, in deployed configuration can substantially 160 millimeters, in folding structureLength l when type can substantially 130 millimeters, and width w can substantially 55 millimeters, and be in deployed configuration when thickness t can be bigIt causes to be 0.5 millimeter.
Surgical implant managing device 100 includes multiple and different feature structure, these feature structures improve user and existTo the managerial ability of silk before and during surgical operation.One such feature structure is implantable retainer 116.As schemedShow, implantable retainer include two staggeredly, opposite tab 118,120, they are configured to catch the phase of implantablePair end.It is consistent that tab 118,120 can be configured to the label 134,136 for being maintained at main body with being formed on device 100Specific position.Therefore, the first tab 118 can be adjacent to 0 millimeter of graticule, and the second tab 120 can be far from the position of the first tab 118Certain distance is set, than the first tab 118 closer to first end 104.Two tabs 118,120 can be configured to respective at itsBase portion 118b, 120b are pivoted, so that end 118e, 120e of tab 118,120, which can be removed, extends substantially across topThe plane on surface 112.According to design, two tabs 118,120 pivotable page-outs (as shown in Figure 2 C), thus allow to be implanted intoOwner's body is collapsed under tab 118,120 and is supported by the other parts of top surface 112.Thus, implement shown inIn example, tab 118,120 can be operable to for implantation material main body being maintained on the top surface 112 of implantation material managing device 100.
Although the size and shape of other parts and implantation material itself based in part on implantation material managing device, canThe tab 118,120 of implant retainer 116 can have various shapes and size, but in an illustrated embodiment, two tabs118,120 have be also described as elongated and half elliptic finger-like shape.The length of each tab 118,120 makes base portion118b, 120b extend in the side of central longitudinal axis L, and end 118d, 120e of identical tab 118,120 are in center longitudinal directionThe opposite side of axis L extends.The geometry can help that implantation material main body is fixed to surface 112 in use.
Another feature structure of device 100 can be an engagement of loops area 122, and (herein referred to as first connectsReceive area), it can be used for keeping and being stretched in the one or more silk rings extended below the bottom side of implantation material main body.Silk engagement of loops area122 can have a variety of different configurations.In Fig. 2 B illustrated embodiment, silk engagement of loops area 122 includes at least one protrusion featuresStructure (two plugs 124 as shown in the figure), and silk ring can be arranged around the plug.Therefore, all rings of implantation material can lead toSingle component is crossed to keep together with tensioning state.Plug 124 can be formed by such mode: along being formed in main body 102Folding part 126 a part of device 100 is folded.More particularly, the second part 128 of device 100 is (as shown in the figureFor the part of device 100 being arranged between folding part 126 and the second end 106) it can be folded towards bottom surface 114, that is, foldingBuild up the page as shown in the figure.Therefore, across main body 102 formed opposite notch or opening 130 with also formed across main bodyCenter cutout or be open 132 combination can form opposite plug 124.In an illustrated embodiment, opposite opening 130 hasThere is generally triangular shape, but a variety of other shapes can also be used to form the opposite opening.In addition, as shown, foldingIntersect with the triangular incision 130 and substantially divided equally in folded portion 126.It is formed by the side of triangular incision 130Taper can help prevent ring from plug 124 slide.
Folding part 126 can extend across the width w of main body 102 between opposite wall 108,110.Those skilled in the artMember is it will be recognized that the position of folding part 126 may depend on many factors, and thus the position of the end of plug 124 can be depended onIn many factors, these factors include the class of the implantation material that integrated implant managing device uses and the operation for using implantation materialType.In some exemplary embodiments, the position of folding part 126, which allows generally for ring, has and is applied to because of engagement plug 124Tension thereon.In some implantation material embodiments, the size of ring can be adjusted using silk branch, so that ring can be in plug 124Upper appropriate tensioning.
Although the plug 124 for forming silk engagement of loops area 122 shown in Fig. 2 B is a part shape by folding main body 102At, but other configurations can also be used to engage the silk ring extended from implantation material main body.For example, in some cases, can fillIt sets and is pre-formed an engagement of loops area 122 on 100, so that not needing to fold initial configuration or do other changes can shapeAt silk engagement of loops area 122.Thus, in some embodiments, plug 124 can be pre-formed in the second end 106 of device 100.
The opening 132 for forming a part of plug 124 can also be used for receiving implantation of ligament object.As shown, graft connectsAt least part for receiving opening 132 may be provided between implantable retainer 116 and plug 124, so that working as implantation of ligamentAt least one of when object is by opening 132, be open by the silk ring of implantation material, as described in further detail below.InstituteIn the embodiment shown, opening 132 is compared for first end 104 closer to the second end 106.
Opening 132 can have various shapes and size, but in an illustrated embodiment, along central longitudinal axis LSymmetrically.Opening 132 can also be folded portion 126 and divide equally, and thus can be symmetrical relative to folding part 126.Therefore, when towards bottom side114 fold second part 128 when, resulting configuration is such a configuration: wherein opening 132 half substantially with opening132 the other half alignment.
The approximate shapes of opening 132 can be similar to dumbbell when in an illustrated embodiment, in deployed configuration.Once foldingAfterwards, the major part 132a of dumbbell shaped opening 132 can be sufficiently large to receive implantation of ligament object, and be open 132 smaller partDivide 132b then can help to form the shape of plug 124.In particular, smaller portions 132b and opposite is arranged in device 100Part between opening 130 forms the plug 124 in silk engagement of loops area 122.As shown in Figure 2 B, the space between two plugs 124124s can form the channel for leading to the opening of rest part of opening 132.In other embodiments, can two plugs 124 itBetween material is set, to eliminate open channel.
Another feature structure of device 100 can be the first label 134 formed on top side 112.First label 134It can be used for multiple reasons, but in one exemplary embodiment, they can help to user and are being connected to device 100Implantation material ring on mark specific measured value.In some cases, the first label 134 can be used in implantation of ligament object subscriptInfuse specific measured value.In an illustrated embodiment, the first label 134 is started and is extended with 0 millimeter close to the first tab 118To being located substantially at 50 millimeters of folding part 126.Every graticule is arranged essentially parallel to the extension of folding part 126.Every real graticule tableShow 10 millimeters of increment, and every empty graticule indicates 5 millimeters of increments between every 10 millimeters of graticules.At the top of deviceOther labels are also still allowed on surface.For example, can also be provided between folding part 126 and the second end 106 on top side 112Two labels 136.As shown, 30 other millis are marked out with 5 millimeters of increment between folding part 126 and the second end 106Rice.According to implantation material and implantation material managing device configuration, the second label 136 can be used for helping in ligament associated with implantation materialSpecific measured value is marked on graft or on the silk of implantation material.
Receiving slit 138 can be formed in main body 102, with received when folding the second end 106 towards bottom side 114 thisTwo ends.As shown in Figure 2 A, receiving slit 138 may be provided between folding part 126 and first end 104, and can be substantiallyIt is parallel to the extension of folding part 126.In an illustrated embodiment, receiving slit 138 be physically located implantable retainer 116 withBetween folding part 126.However, the position of receiving slit 138 can usually depend on the second end folded towards bottom side 114106 shape and length.Therefore, the length between folding part 126 and receiving slit 138 can be substantially identical to second part 128Length.The length and shape in gap 138 can correspond to the shape that the gap is configured to received the second end 106.
Another feature structure that may be incorporated into device 100 is for device 100 to be associated with graft preparation deviceAlignment opening 140.In an illustrated embodiment, be directed at opening 140 is positioned adjacent to implantable retainer 116, implantableBetween body retainer 116 and folding part 126.Hole 140 can have be suitable for receive graft preparation device column various shapes andSize.Those skilled in the art will recognize that graft preparation device can be used in combination with implantation of ligament object, so that can rootMark is made on implantation of ligament object and in implantation material managing device according to disclosure provided herein.Graft preparesThe example of device has been discussed below, and those skilled in the art will recognize that implantation material managing device 100 can be withThe a variety of graft preparation device configurations being used cooperatively.Alignment opening 140 can be generally an elongated, and real shown inIt applies in example, generally teardrop shape.The first end 140a of opening 140 can be configured to big with the column of graft preparation deviceSmall complementation, and the second end 140b can have the diameter bigger than first end 140, make it easier to originally receive column andPositioning implants managing device 100, so that column is in first end 140a engagement device 100.
It helps to manage branch and usually also can be used as from the other various features structures that the top side of implantation material extendsThe feature structure of device 100 and be included.These feature structures may be commonly referred to as silk and keep feature structure, and these are specialThe position of at least some of sign structure on the device 100 is referred to alternatively as second reception area 142 sometimes.In addition to keeping and being implanted intoOutside the associated silk of object, at least some of these feature structures can also apply tension to silk and be deviateed with helping to avoid silk.
Silk keeps an example of feature structure in Fig. 2A and Fig. 2 B as in implantable retainer 116 and first endThe opposite tab 144,146 that is formed between portion 104 and show.As shown, tab 144,146 can be from center longitudinal axis LIt is substantially equally spaced apart, and can be described as horizontally being arranged relative to central longitudinal axis L.Each tab 144,146It may include two folding part 144b, 144c and 146b, 146c.It can be formed between tab 144,146 and main body 102 and be set more between two partiesFirst folding part 144b, 146b set, so that tab 144,146 be allowed to be moved out of the plane for extending substantially across main body 102.In an illustrated embodiment, as shown in Figure 2 D, tab 144,146 can be configured to along implantable retainer tab 118,120Relative direction it is mobile, and thus can be extended in the page when folding.Each tab 144,146 can be along the second folding part144c, 146c are folded, and to provide reception area 144r, 146r, and silk can be wound around the reception area.As shown in Figure 2 D, tab144,146 end 144e, 146e can be arranged essentially parallel to the plane for extending substantially across main body 102.It is related to implantation materialAny any and all parts of connection can be wound around tab 144,146, as described in greater detail below.Tab 144,146 can help to make each silk to keep orderly, and a possibility that can also reduce any entanglement.It is wound around tab 144,146Silk can also make silk keep tensioning state.
The gap 148 being centrally located can be formed in first end 104, and is allowed to extend to tab 144,146.Gap148 can be used as the inlet point of the silk before winding silk to be placed around tab 144,146.As shown, gap 148 terminatesIn the hole 150 for extending through main body 102.A part of silk can be arranged in hole before winding silk around tab 144,146In 150.
For keeping another feature structure of silk by extending through main body 102 and being configured to receive any and allThe hole 152 of silk provides.Hole 152 may be provided in second reception area 142, close to first end 104, in the first opposite wall 108And second between one of opposite wall 110 and the gap 148 being centrally located.Gap 154 can be connected to and may extend away with hole 152To the opposite wall (the first wall 108 as shown in the figure) closest to hole 152.As shown in Figure 2 C and 2 D shown in FIG., silk can around tab 144,146 windings extend from tab 144,146 to hole 152, and can be slid through gap 154 and access aperture 152.In addition to maintaining silkTensioning state tab 144,146 except, in some embodiments, hole 152 may also aid in maintain silk tension, for example, working asWhen hole 152 has diameter similar with the overall diameter for the silk being disposed therein.
Tab 156 is kept to can be used as another feature structure for facilitating silk holding and management and provide.As shown, protectingHolding tab 156 can position along one of opposite wall 108,110 (the first wall 108 as shown in the figure), and than hole 152More centrally it is arranged along wall 108 with gap 154.In particular, keeping tab 156 that can be arranged along the length l of main body 102Between opposite tab 144,146 and implantable retainer 116.Keep tab 156 can be by from wall 108 to center longitudinal axisTwo gaps 158,160 that line L extends, being roughly parallel to folding part 126 are formed, and may include wherein being formed, bigCause two folding parts 156b, 156c perpendicular to two gaps 158,160.Folding part 156b, 156c allow the formation of tab 156For receiving the casing of silk, and at least in some cases, tension can be applied to the silk being disposed therein and/or maintain settingIn the tension of silk wherein.The folding part 156b being more centrally located can be formed between main body 102 and tab 156, so that prominentPiece 156 extends into or extends page-out.Second folding part 156c allows the end 156e of tab 156 to turn back to main body 102To form casing, as shown in Figure 2 C and 2 D shown in FIG..By keeping silk towards the edge of device 100, user can more easily be observedImplantation material ring, implantation of ligament object and label 134,136, without by silk block vision.
Fig. 2 C and Fig. 2 D show device 100, with implantation material 10 associated therewith.As shown, implantation material 10Main body 12 can be maintained at desired position by implantable retainer 116, so that the starting point from the bottom side 12b ring 14 extended is bigIt causes at 0 millimeter of graticule.Ring can extend to silk engagement of loops area 122, and can be held in place by plug 124 with tensioning state.Therefore, it is made of for receiving the opening 132 of implantation of ligament object ring 14.
Adjustable branch 15a, 15b and also each of two guide wires 16,18 associated with main body 12 can be fromMain body 12 extends to first end 104.Branch 15a, 15b and guide wire 16,18 may pass through gap 148 to the hole being centrally located150 extend, then can be around tab 144,146 in 114 underlying wound of the bottom side of device 100.Branch 15a, 15b and guide wire16,18 can extend to the first wall 108, they can be arranged in side slit 154 with access aperture 152 in the first wall.BranchThen 15a, 15b and guide wire 16,18 can extend to silk engagement of loops area 122, and can be kept tab 156 before final terminateCasing is formed by catch.Further details about the technology that implantation material is attached to device or card are below in conjunction with Figure 15 L-S is more fully described.
As shown, the first label 134 can be used for marking measured value on ring 14, because 0 millimeter of graticule and ring 14 are oppositeIt is overlapped in the approximate starting point of main body 12.Second label 136 can use in one of two modes.As shown in Figure 2 D, the second label 136On the bottom side of device 114.In one exemplary embodiment, the second end 106 can from receiving slit 138 be removed andReturn to roughly its position for being in deployed configuration.Then, the ligament for being arranged in ring 14 and being extended far from plug with direction AGraft can have the measured value marked on it using the second label 136, as described in greater detail below.Alternatively, ligament movesPlant can be associated with ring, extends then along bottom side 114 to first end 104, so that when main body 102 is in folding configurationWhen the second label 136 can be used to mark measured value on implantation of ligament object.
The alternative embodiment of implantation material managing device
The various other embodiments of Fig. 3 A- Figure 13 offer implantation material managing device.Feature structure shown in these embodimentsIncluding some identical feature structures and other feature structure described in the device relative to Fig. 2A-Fig. 2 D or Fig. 2A-Fig. 2 DDevice same characteristic features structure alternative embodiment.Those skilled in the art will recognize that including one in these embodimentsIn feature structure this meaning in a embodiment but in non-other embodiments, without departing from the spirit of the present disclosure,It usually can modify to each embodiment to include or exclude specific feature structure.In addition, in some feature structuresIt is shown in this meaning in various embodiments, such feature structure can be for efficiency purposes without retouching in each exampleIt states.Those skilled in the art will recognize that the configuration mode of feature structure shown in these, and can be according to the disclosureThe knowledge of complete content and technical staff use the mode of these feature structures.In general, have between different embodimentsThe feature structure of comparable conformation numbers (for example, 198,298,398) in a similar manner, and plays similar purpose but have differenceThe feature structure of configuration numbers in a similar manner but has apostrophe (for example, 198,298', 398 ").
Implantation material managing device or card in deployed configuration and folding or compact configuration is shown respectively in Fig. 3 A and Fig. 3 B200.Device 200 is with the similar place of the device of Fig. 2A-Fig. 2 D: it has with main body 202, the main body by first end204, the second end 206 and the opposite wall 208,210 extended between two ends 204,206 limit substantially rectangular in cross sectionShape；It has the central longitudinal axis L that the length along main body 202 extends；And it further includes 212 He of top side or top surface214 (not shown) of bottom side or bottom surface.The device further includes such as following characteristics structure: implantable retainer 216；AlignmentOpening 240；The plug 224 that a part as silk engagement of loops area 222 is formed, wherein silk engagement of loops area passes through along foldingPortion 226 folds second part 228 and is inserted into the second end 206 and keeps gap 238 and generate；Opposite opening 230；TransplantingObject receiving opening 232；First label 234；Second label 236；The silk being formed in second reception area 242 keeps feature knotStructure, such as horizontally disposed silk keep tab 244,246；Multiple holes 250,252 and gap 248,254；And keep tab256。
Although having many similar feature structures, the device 200 of Fig. 3 A and Fig. 3 B are considerably longer than Fig. 2A-Fig. 2 D'sDevice 100.As shown, when being in deployed configuration, substantially 220 millimeters of the length l of device, and when being in folding configuration, it is longSubstantially 160 millimeters of l of degree.The longer device 200 allows to mark longer survey on the ring of implantation material associated therewithMagnitude, because folding part 226 is far from 216 substantially 80 millimeters of implantable retainer.Longer device can be used for collateral ligament reparation(for example, medial collateral ligament (MCL) or medial patellofemoral Ligament (MPFL) are repaired), wherein the length of implantation material ring is usually longer,In the range of about 80 millimeters to about 120 millimeters.In some embodiments, the length of implantation material ring can be about 80 millimeters, and oneIn a little other embodiments, the length of implantation material ring can be about 90 millimeters.Shorter device (similar device 100) can be used for intersecting toughBand repairs (for example, ACL or posterior cruciate ligament of knee (PCL) repair), and wherein usually no more than about 50 millimeters of the length of implantation material ring is extremelyAbout 70 millimeters.In some embodiments, the length of implantation material ring can be about 60 millimeters.
As device 200 a part and another feature structure that is included refers to that beacon infuses (arrow as shown in the figureIt is first 262).It the position of arrow 262 can be adjacent to graft receiving opening 232, so that indicating for user should incite somebody to action in useThe setting of implantation of ligament object is in opening 232.Other guidance marks can also be provided on top surface 212 and bottom surface 214,And some other non-limitative examples of such mark are provided in other embodiments.When device is with wrapped shapeGuidance mark can be particularly useful when formula occurs, user can easily device for identifying various feature structures and functionEnergy.
Similar to device 100, the holding gap 238 for receiving the second end 206 may be provided at first end 204 and moveBetween the starting point of plant receiving opening 232.However, due to the length substantially class of second part 228 in an illustrated embodimentIt is similar to the length of the second part 128 in first device 100, but the length between first end 204 and folding part 226 is substantiallyIt is longer than in the device 100, thus the position in gap 238 than similar gap 138 further from implantable retainer 216.
Fig. 4-Fig. 8 provides the other alternative configuration of implantation material managing device.Different from two embodiments before, theseEmbodiment does not show deployed configuration and folding or compact configuration simultaneously.Although illustrating only compact structure in the device of Fig. 4-Fig. 8Type, but shown in configuration can be using as described herein or in other words technology known to those skilled in the art is rolled overFolded result.Configuration shown in alternatively, can be unique configuration provided by main body, because that can obtain without being foldedShown in configuration.
Each of these alternative configurations of Fig. 4-Fig. 8 are for the implantation with main body 302,402,502,602,702Object managing device 300,400,500,600,700, these main bodys have by first end 304,404,504,604,704, and secondEnd 306,406,506,606,706 and in two ends 304 and 306,404 and 406,504 and 506,604 and 606,704With 706 between opposite wall 308 and 310,408 and 410,508 and 510,608 and 610,708 and 710 that extend limit substantiallyFor rectangular shape.Each further includes top side or top surface 312,412,512,612,712 and bottom side or bottom surface314,414,514,614,714, and the central longitudinal axis that there is the length along main body 302,402,502,602,702 to extendThe position of L, axis L are defined before this in conjunction with other embodiments.Since illustrated embodiment is in compact configuration,Shown in the second end 306,406,506,606,706 be located at folding part 126,226 is identified as in embodiment in the early timeAt part.Such mark be not precluded be maintained at the device 300 for keeping the second end in gap, 400,500,600,700 deployed configuration, as described in relative to device 100,200.
In the implantation material managing device 300 of Fig. 4, device 300 includes positioned at the silk engagement of loops area 322 of the second end 306(for example, plug 324), graft receiving opening 332 and the label 334' on top surface 312.Embodiment illustrated is notIncluding implantable retainer.On the contrary, implantation material can be maintained at 0 millimeter of graticule with marking ring as needed and tough by userBand graft.In addition, as shown, label 334' can be slightly angled compared with the near linear formed by first end 304.The angled line allows the anatomical structure for more realistically showing the ring being marked.It has been found, however, that in majority of caseUnder, for the label, it can be neglected using straight line and the difference for any accuracy being labeled using angled lineSlightly disregard.
Implantation material managing device includes the multiple holding feature structures for keeping the silk extended from implantation material, for example,Adjustable branch, first seal wire and hangover silk.The feature structure can be formed in second reception area 342 of main body 302, andIt and may include (for example) a pair of opposite tab 344', 346'.Tab 344', 346' and tab 144,146 in the embodimentIt is all different with 244,246, because they form differently and different positions is arranged in.
Tab 344', 346' are only formed from single folding part 344b', 346b'.Tab 344', 346' can be bent to prolongPage-out is put in or extends, then silk can be wound close to folding part 344b', 346b' around tab 344', 346'.About themPosition, two tabs 344', 346' can be centrally located on the device 300, so that central longitudinal axis L is substantially by tab344', 346' divide equally.It is referred to alternatively as being vertically arranged relative to central longitudinal axis L herein with the tab that this direction extends.As shown, two tabs 344', 346' are substantially equidistant with 0 millimeter of graticule, but other positions are certainly possible to, including thisSome positions provided in text.In some cases, the silk around tab 344', 346' winding can help be not present and can plantThe position of implant is maintained in the case where entering body retainer.Although there is no the seams extended from one of wall to tab 344', 346'Gap, such as the gap 148,248 of device 100,200, but such gap may include in the alternate configuration of device 300.
Second reception area 342 can also be included therein the multiple holes to be formed (as shown in the figure three hole 352a,352b, 352c), each hole 352a, 352b, 352c have extend from first end 304 gap 354a associated therewith,354b,354c.Each hole 352a, 352b, 352c can be used for keeping different silks.For example, the first hole 352a can be used for keep canThe branch of adjusting, the second hole 352b can be used for keeping guide's suture, and third hole 352c can be used for keeping hangover suture.Pass throughDifferent silks is kept using each hole, the ability that user distinguishes various silks can be improved, and may also help in reduction silkBetween a possibility that tangling.In an illustrated embodiment, the diameter of third hole 352c is than the first hole 352a's and the second hole 352bDiameter is big, but based in part on the quantity and size of silk associated with implantation material, appointing for diameter can be usedMeaning combination and any amount of hole.
Device 400 shown in fig. 5 is similar to the device 300 of Fig. 4, unlike it include implantable retainer 416' withAnd alignment opening 440' with graft preparation device to integrate.In addition, label 434', 436' for being provided on top surface 412It can use in two directions.The feature structure of the device, such as silk engagement of loops area 422 (such as plug 424), graft receiveOpening 432 and the silk that is formed in second reception area 442 keep feature structure, and (such as the silk being vertically arranged keeps tab444', 446' and hole 452a, 452b, 452c and gap 454a, 454b, 454c), can have Fig. 4 as described herein in and itsProperty described in its disclosed embodiment.
Implantable retainer 416' allows the main body of implantation material substantially horizontally to extend relative to central longitudinal axis L,That is, horizontal alignment.Implant is maintained at by previously mentioned embodiment to be vertically oriented.The tab of implantable retainer 416' canIt is configured to fold into or fold out paper along folding part 416b', to allow to collapse implantation material main body under tab.SeparatelyOutside, in some embodiments, tab may include being configured so that user is easier to catch the one or more of tab 416'Finger-shaped material 416f'.
The alignment opening 440' provided in Fig. 5 is substantially circular, the alignment opening 140,240 with device 100,200Shown in more elongated configuration it is opposite.Those skilled in the art will recognize that based in part on graft preparation deviceCorresponding column shapes and sizes, a variety of other shapes can be used to help implantation material managing device and graft preparation deviceIntegration.
Label 434', 436' on top surface 412 are different from the label of any previously mentioned embodiment, because theyIt is arranged at identical position and is configured to permit and easily used in two directions on the same side of device, andWithout expanding unit 400.As shown, the first label 434' starts from the position of implant retainer 416' with 0 millimeter, and toFirst 50 millimeters reach close to the position of plug 424, and the second label 436' is started from 0 millimeter close to the position of plug 424, and toThe position of preceding 50 millimeters of arrival implantable retainer 416'.The second label 436' is provided in the position to allow in compact configurationIn by be located at top surface 412 on label based on be easy to carry out implantation of ligament object measurement, because of the beginning of such measurementIt position usually can be at or near the second end 406.
Fig. 6 shows another embodiment of implantation material managing device 500.Device 500 it is similar with the device 400 of Fig. 5 itBe in: it include implantable retainer 516', alignment opening 540', graft receiving opening 532, as silk engagement of loops areaThe plug 524, first that 522 a part is formed marks the label 536' of 534' and second, and is formed in second reception area 542In silk keep feature structure (for example, the silk that is vertically arranged keeps tab 544', 546').In addition, keeping feature knot as silkStructure additionally provides the hole 550,552 and gap similar with the hole 150,152 of the device 100 of Fig. 2A-Fig. 2 D and gap 148,154548,554'.Although the silk of device 500 keeps equivalent tab 444', 446' of tab 544', 546' similar device 400 equally perpendicularStraight setting, but different positions is arranged in they.In addition, device 500 provides the guidance mark provided on top surface 512Additional examples.
As shown, silk keeps the longitudinal direction still relative to each other, and that tab 544', 546' are divided equally tab 544', 546'Axis L' is arranged essentially parallel to central longitudinal axis L, however, they are being filled unlike tab 444', 446' in device 400It sets and is centrally located on 500.On the contrary, tab 544', 546' are deviated to the side of central longitudinal axis L, as shown in the figure compared to theTwo walls 510 are closer to the position of the first wall 508.In addition, the length l of the device is substantially longer than the length of device 400, this permissionSilk keeps tab 544', 546' to be spaced apart a certain distance with label 534', the 536' formed on top surface 512.Therefore,When silk is kept tab 544', 546' setting around silk, since the silk of winding is not set up directly on appointing for label 534', 536'On what part, so as to more easily observe label 534', 536'.
Gap 548 and hole 550 can be used for helping to keep tab 544', 546' setting silk around silk.Gap 548 can be formed inIt in first end 504, is centrally located in main body 502, so that its end edge for being arranged essentially parallel to tab 544', 546'A part of length of central longitudinal axis L extends.Gap 548 can keep tab 544', 546' to extend to silk, terminate at and extend throughCross the hole 550 of main body 502.Can by silk around tab 544', 546' winding before make silk a part pass through gap 548 andIt is arranged in hole 550.
The combination of second gap 554' and hole 552 can be formed along the edge of main body 502, silk winding silk is being kept prominentSilk is received after piece 544', 546'.As shown, the second gap 554' can be formed in the first wall 508, neighbouring main body 502Turning.Gap 554' can diagonally extend relative to central longitudinal axis L, and may terminate at the second hole 552.It is kept from silkThe silk that tab 544', 546' extend may pass through gap 554' and be arranged in hole 552, to help to manage silk.Due to the second seamThe adjacent edges of main body 502 are arranged in gap 554' and hole 552, therefore they help to avoid the visual field that silk blocks user, and allowing makesUser can more easily observe ring, implantation of ligament object and label 534', 536'.
The other guidance mark of two be arranged on top surface 512 is also shown in the device of Fig. 6.A kind of such mark isThe alternative embodiment of arrow 562', for user indicate should by implantation of ligament object be arranged where.Arrow 562' risesTo 262 similar purpose of arrow with device 200, but there is different appearances.Those skilled in the art will recognize that makingCan be used to indicate when with device provided in this article the part of implantation of ligament object or implantation material itself should to be arranged or in other wordsIt says and is placed on the other arrow types of where a variety of and other instruction types.Second of such mark is the figure of writing implementAs 564.Image 564 is that user indicates and the side (that is, top side 512) of device 500 can be used in device itself, implantation materialIndicator is marked in any one in implantation of ligament object and whole.
Another embodiment of implantation material managing device 600 is shown in FIG. 7.Device 600 discussed before this including someFeature structure, including implantable retainer 616, graft receiving opening 632, as the one of silk engagement of loops area 622Plug 624 that part is formed, label 634, and silk in second reception area 642 keep feature structure (such as to set verticallyThe silk set keeps tab 644', 646' and hole 650,652 and gap 648,654, but gap 654 is formed in the second wall 610,And associated hole 652 is located proximate to the second wall 610).It is to set between two parties that the silk being vertically arranged, which keeps tab 644', 646',Set so that central longitudinal axis L divides two tabs 644', 646' equally, and they be spaced apart with label 634 it is certain away fromFrom.The device further includes the other fiber tube reason feature structure between implantable retainer 616 and silk engagement of loops area 622666。
As shown, feature structure 666 may include two staggeredly, opposite tab 668,670, they be similar to deviceThe tab 118,120 of 100 implantable retainer 116.Tab 668,670 can be located at implantable retainer 616 and transplantingBetween object receiver hole 632.Two tabs 668,670 can be configured to pivot at its corresponding base portion 668b, 670b, so thatEnd 668e, 670e of tab 668,670 can remove the plane for extending substantially across main body 602.According to design, two prominentPiece 668,670 pivots page-out, thus allows for a part of ring to be clipped under tab 668,670 and close to top surface612 are held in place, wherein a part of the ring extends from the bottom side of implantation material associated with implantable retainer 616.Then ring can extend from tab 668,670 to plug 624, still constitute graft receiving opening 632 so that ring can receive ligamentGraft.Tab 668,670 can help to prevent various rings entangled with one another, and can help ensure that and make a reservation for be used to receive implantation of ligamentEach ring of object is correctly positioned to receive implantation of ligament object.In an illustrated embodiment, tab 668,670, which is substantially centered, setsIt sets, so that they are substantially divided equally by longitudinal axis L.In addition, making as shown, tab 668,670 can be substantially longitudinally alignedThe base portion 668b for obtaining a tab 668 is substantially aligned with the end 670e of another tab 670.In other embodiments, tab668,670 can be longitudinally aligned, so that the end 670e of tab 670 is terminated before the base portion 668b of tab 668, it is similar to deviceThe alignment of the tab 118 and 120 of 100 implantable retainer 116.
Second gap 654 and the second hole 652 are located in main body 602, so that 646b' pairs of base portion of they and tab 646'It is quasi-.Therefore, the silk around tab 644', 646' winding can extend horizontally across the base portion of tab 646' and be directly entered secondGap 654, subsequently into the second hole 652, to be maintained at the adjacent edges of main body 602.This is to will definitely help to alleviate can not in silkThe tension taken, while still silk being avoided to block user.
Another configuration of implantation material managing device 700 is shown in FIG. 8.Device 700 includes some discussing before thisFeature structure, including implantable retainer 716, graft receiving opening 732, as a part of shape in silk engagement of loops area 722At plug 724, label 734, guidance mark (such as arrow 762), and the silk that is formed in second reception area 742 keepsFeature structure (such as the silk being vertically arranged keeps tab 744 ", 746 " and hole 750a, 752a and gap 748a, 754a).It is perpendicularThe silk that is directly arranged keep described in tab 744 ", 746 " and previous embodiment the difference is that: they are opposite but thatWhat this was staggered.
As shown, each tab 744 ", 746 " may include the first wall 744a ", 746a " and the second wall 744b ", 746b ",Wherein the second wall 744b " of the first tab 744 " is close to vertically-aligned with the first wall 746a " of the second tab 746 ".In addition such asShown in figure, the second wall 746b " of the second tab 746 " can be substantially aligned with central longitudinal axis L.In addition, tab 744 ", 746 "Width 744w ", 746w " be smaller than the width that similar silk in previously described embodiment keeps tab, for example, silk keeps tab144, the width of 146 and 644', 646'.As shown, the width in the first tab 744 " and the second tab 746 " eachSimilar silk keeps the half of the width of tab in the substantially previously described embodiment of 744w ", 746w ".However, due to the twoTab offsets one from another, therefore by between the first wall 744a " of the first tab 744 " and the second wall 746b " of the second tab 746 "The width that distance is formed can be substantially equal to the width that silk similar in previously described embodiment keeps tab.As shown, twoFolding part 744b ", 744c " and 746b ", 746c " can be formed in each tab 744 ", 746 ", wherein folding part 744b ",744c " and 746b ", 746c " operation be similar to device 100 tab 144,146 folding part 144b, 144c and 146b,146c。
Two gaps 748a, the 754a and hole 750a, 752a being formed in main body 702 in combination with silk keep tab 744 ",746 " operations, to guide and/or maintain the silk extended from the top side of implantation material main body associated with device 700.It is centrally locatedGap 748a and hole 750a can be substantially vertically-aligned with the second wall 746b " of the second tab 746 ".Second gap 754a andHole 752a can have a construction similar with gap 748a and hole 750a, but as shown, can substantially with the first tab 744 "First wall 744a " is vertically-aligned.Therefore, a part of silk can be passed through before by silk winding tab 744 ", 746 " and is centrally locatedGap 748a and be arranged in the 750a of hole, then another part of silk can by silk around tab 744 ", 746 " wind afterAcross the second gap 754a and it is arranged in the second hole 752a.Gap 748a, 754a and hole 750a, 752a substantially with wall746b " and 744a " is vertically-aligned to help that silk is prevented to tangle, and reduces unnecessary tension in silk.In addition, due to second prominentPiece 746 " intersects with a part of label 734, therefore the reduction of 746 " size of tab and its center hair relative to main body 702The fact that raw offset, can reduce vision caused by fold-down tab 746 " (entering the page) in use and hinder.This structureType can also help to mitigate to the label on the bottom side for being formed in main body 702 (for example, facilitating on implantation of ligament object to measureLabel) generate any vision hinder.
Fig. 9 and Figure 10 A provides two kinds of alternative implantation material managing devices 800,900 in deployed configuration respectively, theyThe non-limiting example of the second end 806', 906 " that are shaped differently are shown.In general, device 800,900 includes oppositeIt is multiple in the same characteristic features structure shown in the device 100,200 of Fig. 2A-Fig. 2 D and Fig. 3 A- Fig. 3 B.Therefore, as shown,Device 800,900 all has main body 802,902, and the main body has substantially rectangular in cross section shape, and the shape is by first end804,904, the second end 806', 906 " and extend between two ends 804,806' and 904,906 " respectively oppositeWall 808,810 and 908,910 limits.Each device 800,900 further includes longitudinal along the center that the length of main body 802,902 extendsAxis L, and further include top side or top surface 812,912 and bottom side or bottom surface 814,914 (not shown).In deviceThe other feature structure of middle offer can include: the implantable retainer with opposite tab 818,820 and 918,920816,916；Alignment opening 840,940；Second part 828,928, be configured to along folding part 826,926 to bottom side 814,914 fold (that is, into page) to form the silk engagement of loops region for including plug；Opposite opening 830,930；Graft receivesOpening 832,932；First label 834,934；Second label 836,936；The silk being formed in second receiving area 842,942Holding feature structure, such as horizontally disposed silk holding tab 844,846 and 944,946, multiple holes 850,852 and 950,952,Gap 848,854 and 948,954, and the holding tab 856,956 with gap 858,860 and 958,960.
As shown in figure 9, the second end may include U-shaped notch 872 in an alternative embodiment.Two tapered sidesEdge 806a', 806b' can extend to opposite wall 808,810 from the end 872t of notch 872.When main body 802 is along folding part826 fold, and when so that second part 828 being moved in the page to bottom side 814, two tapered edge 806a', 806b' can be setIt sets in complementary holding gap 838a', 838b' between the folding part 826 being formed in main body 802 and first end 804.As shown, keep gap 838a', 838b' to be arranged to and be directed at a part of opening 840 in line, it is close to can plantBody retainer 816, because the length of second part 828 is almost the same with the length for extending to folding part 826 from 0 millimeter of graticule.UShape notch 872 and allowing to be aligned opening 840 and being not blocked helps that main body 802 is prevented to interfere graft preparation device.CauseAnd it is enough the other structures feature of countermeasure set 800, implantation material or in connection when the label 826 on second part 828 hasWhen the length of the other structures (e.g., graft preparation device) used, which is available.
The alternative embodiment of Figure 10 A provides the second end 906 " with zigzag fashion.In an illustrated embodiment,Two ends 906 " have M shape or W-shape so that there are three end peak 906a ", 906c ", 906e " and two end paddy 906b ",906d".The holding gap 938 formed between folding part 926 and first end 904 can be configured to receive the second end 906 "The part holding paddy 906b " at two, extending between 906d ", including central end peak 906c ".In addition, the position in gap 938 canDepending on folding the length of the second part 928 of (that is, into the page in) to bottom side 914.In an illustrated embodiment, with transplantingThe end 932t of object receiving opening 932 is compared, and keeps gap 938 closer to the end 940t of alignment opening 940.
The alternate embodiment of Figure 10 B offer device 900', device 900 of the configuration generally similar to Figure 10 A of the device, butIncluding the implantable retainer 916' being configured differently and the silk being configured differently holding feature structure, more particularly, withHolding tab 956a', 956b' that the holding tab 956 of Figure 10 A is configured differently.As shown, the implantable of Figure 10 B is protectedOpposite tab 918', 920' of holder 916' has the bigger surface area of tab 916,918 of the device 900 than Figure 10 A.ThisA little biggish tab 918', 920' allow more easily to keep biggish implantation material main body with device 900'.Biggish implantation materialMain body can be used for needing the surgical operation of larger bone hole, or the case where surgeon drills out than being initially expected bigger bone holeLower use.In such cases, the length of implantation material main body or diameter can be configured to the diameter greater than bone hole, thus can preventImplantation material main body slides into bone hole and implantation material is prevented to lose its implantation position.
It keeps tab 956a', 956b' to play the purpose similar with tab 956 is kept, thus can keep from implantation material main bodyTop side extend extra silk.Although can be used for keeping silk there are many configuration, in an illustrated embodiment, tab 956a',The configuration mode of 956b' is similar to the opposite tab of implantable retainer provided herein (for example, Figure 10 A's is opposite918,920 or Fig. 7 of tab opposite tab 668,670) configuration mode.As shown, the position of tab 956a', 956b'The wall 908' of nearly main body 902' is rested against, so that it is guaranteed that silk is disposed further from the mark formed on the top surface 912' of main body 902'Remember 934', and is staggered relative to each other.Tab 956a', 956b' can be configured in its respective base portionIt is pivoted at 956ab', 956bb', so that end 956ae', 956be' of tab 956a', 956b' can be removed and substantially be prolongedExtend through the plane of main body 902'.According to design, tab 956a', 956b' pivot page-out, thus allow to collapse silkIt is supported under tab 956a', 956b' and by the other parts of top surface 912'.In an illustrated embodiment, tab956a', 956b' are substantially longitudinally aligned so that the base portion 956ab' of a tab 956a' substantially with another tab 956b'End 956be' alignment.Equally, the base portion 956bb' of tab 956b' is substantially aligned with the end 956ae' of tab 956a'.?In other embodiments, tab 956a', 956b' can be longitudinally aligned, so that end (such as end of tab 956b' of a tabPortion 956be') it is terminated before the base portion (such as base portion 956ab' of tab 956a') of another tab.
Figure 11 shows the implantation material managing device in deployed configuration or blocks 1000 another embodiment.The Ka1000TeInstruction She Jiyongyu not be provided on card itself, to help user that the card of expansion is converted into the implantation being stored thereonThe scored card of object and implantation of ligament object associated there.In particular, providing greater number of point on top surface 10121076,1078,1080 and 1082, to indicate that user executes the sequence of step, i.e. scored card 1000, addition implantation material, additionImplantation of ligament object and storage silk associated with the implantation material on card 1000.
As shown, card 1000 has main body 1002, which has by first end 1004', 1006 and of the second endThe substantially rectangular in cross section shape that the opposite wall 1008,1010 extended between two end 1004', 1006 limits.Card 1000Central longitudinal axis L with the length extension along main body 1002, and further include top surface 1012 and bottom surface 1014(not shown).A pair of of folding part 1025,1026 is provided, the folding part is substantially with the horizontal direction of central longitudinal axis LExtend, the configuration of expansion is divided into first segment 1074a, second section 1074b and third segment 1074c.
1: 1076 is provided, close to implantable retainer 1016 ", implantable retainer 1016 " itselfPosition is substantially in the center of second section 1074b.In an illustrated embodiment, the configuration of implantable retainer 1016 " is differentIn previously described implantable retainer.As shown, implantable retainer 1016 " is substantially along center longitudinal axisThe single vertical gap that line L extends.The first step indicated by 1: 1076 may include that implantation material main body is passed through implantableThe gap of retainer 1016 " reaches bottom side 1014 from top side 1012, while ensuring that at least part of silk extending therefrom is being pushed upOn side 1012.The silk for forming the ring of implantation material can extend across the first hole that vertical gap end is formed from implantation material main body1015 ", and the silk from adjustable branch, guide's suture and the suture that trails can be extended across from implantation material main bodyThe second hole 1017 " that the opposing end portions in vertical gap are formed.Thus, which it is appropriate on card 1000 can be maintained at implantation materialAt position.In an illustrated embodiment, the diameter in the second hole 1017 " is greater than the diameter in the first hole 1015 ", because of the second hole1017 " can be configured to remain at the bigger silk of thickness, but based in part on silk associated with implantation materialType, quantity and thickness, the hole of other sizes also can be used.
The position for the implantation material main body being placed on card 1000 will usually make the part base near implantation material main body of ringIt is aligned in sheet with 0 millimeter of graticule, to ensure accurately to mark on device, implantation of ligament object and/or implantation material.Implement shown inIn example, the label 1034' on top surface 1012 diagonally extends relative to central longitudinal axis L.In addition, as shown, mentioningThe guidance supplied on the image 1064 of writing implement marks, and label 1034' can be used in device itself, plant to show userEnter and marks indicator in any one in object and implantation of ligament object and whole.
Two points 1078 can be located on second part 1074b, close to folding part 1026.Two points 1078 can just easilyIt is located on Part III 1074c well, close to folding part 1026.Arrow 1084 can be located at two points, 1078 side, and can be matchedBeing set to and showing second step includes that Part III 1074c is folded (that is, into the page in illustrated embodiment in) to bottom side 1014.Therefore, it is substantially perpendicular to the label 1036 on the Part III 1074c of longitudinal axis L as shown in the figure for institute elsewhere hereinThe purpose stated and be arranged in bottom surface 1014.The second end 1006 as Part III 1074c a part may includeCentral flap 1007 with circular edge, the edge are configured to the receiving slit by being formed on second part 1074b1038 receive.Similar with other embodiments, receiving slit 1038 can be set in graft receiving opening 1032 and first endBetween 1004'.In this embodiment, gap 1038 is physically located between the second hole 1017 " and the second folding part 1025, becauseThe length of Part III 1074c is too long.
First folding part 1026 can substantially divide graft receiving opening 1032 equally, thus by Part III 1074cIt folds on second part 1074b, obtains and the similar opening that is open described in other embodiments herein.However, with institute before thisThe embodiment stated is different, and there is no two triangle open mouths equally divided equally by folding part 1026.On the contrary, and central longitudinal axisThe opening 1030' that is opposite, matching that L is equidistantly formed is terminated at folding part 1026, so that folding by Part III 1074cWhen on to second part 1074b, a part of Part III 1074c blocks opening 1030' from bottom side 1014.However, at least becauseFor the flexibility of card 1000, the ring from implantation material can be still arranged on by the way that Part III 1074c is folded into secondIt is divided on 1074b and on two plugs 1024 of formation.Plug 1024 can retaining ring be in tensioning state, and the configuration shown permitXu Huan receives the implantation of ligament object being arranged in graft receiving opening 1032.
Three points 1080 can be located on Part III 1074c, the neighbouring arrow for being directed toward graft receiving opening 10321062'.Three points 1080 can indicate third step be implantation of ligament object is arranged through to graft receiving opening 1032, thus by byThe implantation material ring that plug 1024 is tensioned receives.The image of implantation of ligament object 1086 can also be provided on top surface 1012, withHelp shows the purpose of arrow 1062'.
(it may include adjustable branch, guide's suture and hangover suture to the silk extended from the top side of implantation material main bodyLine) it can be configured to extend from implantable retainer 1016 " to first part 1074a.First part 1074a may include oneOr multiple holding feature structures.As shown, it includes 1048 He of gap being centrally located that the silk of card 1000, which keeps feature structure,Hole 1050, and be formed in the first wall 1008 and the second wall 1010 of main body 1002 two it is opposite, it is substantially V-shapedNotch 1088.Silk can be passed through gap 1048, and its a part can be maintained in hole 1050, it then can be by substantiallyThe remainder of silk is wrapped on two V-notch 1088 perpendicular to the direction of central longitudinal axis L.
Four points 1082 can be located on second part 1074b, close to folding part 1025.Four points 1082 can just easilyIt is located on first part 1074a well, close to folding part 1025.Arrow 1090 can be located at four points 1082, and canBeing configured to show the 4th step includes folding first part 1074a (that is, into the page in illustrated embodiment to bottom side 1014It is interior).Alternatively, (that is, leaving the page in illustrated embodiment) can be folded to top side 1012 by first part 1074a.First end1004' may include the central flap 1005' with circular edge, and the edge is configured to by the shape on second part 1074bAt the second receiving slit 1039' receive.As shown, the second receiving slit 1039' can close to the first receiving slit 1038,But the position in two gaps may depend on the ruler that they are configured to received first part 1074a and Part III 1074cIt is very little.
By folding first part 1074a, it can prevent a part for the silk being wrapped on V-notch 1088 from having an accidentAbrasion or cutting, because a part of silk is arranged between two parts 1074a, 1074b.Can in first part 1074a andCentrally located diamond opening 1092 is provided between second part 1074b, when first part 1074a is folded into second partWhen on 1074b, which will become v-shaped opening.When folding first part 1074a to second part 1074b, diamond is openedMouthfuls 1092 can help to provide to silk when silk is moved to closer to implantation material main body needed for tension.Therefore, silk will not graspedUser is adversely unclamped and interfered during making.
Those skilled in the art will recognize that without departing from the spirit of the present disclosure, being described in conjunction with card 1000The instruction of property be applicable to that there are a variety of configurations and a variety of different feature structures (for example, hole, opening, gap, tab)Device and card.In addition, those skilled in the art will recognize that, it can block based in part on the configuration of card and useThe type of operation, to change number, the number amount and type of instruction, thus can be with including more, less or different step instructionDerived from the disclosure for including herein.The teaching content of instruction provided herein can be easily adaptable disclosed herein, any and all devices and card derived from it, or suitable for known to those skilled in the art with other configurationsImplantation material managing device and card.
Figure 12 is another example of the implantation material managing device 1100 in deployed configuration, can be folded to the deviceTo protect at least part of implantation material.When packing implantation material and implantation material managing device for distributing and selling,Alternatively, the protection part of implantation material can be available before the surgery with period in surgical site.
As shown, implantation material 1100 has main body 1102, main body 1102 has by first end 1104, the second endThe rectangular shape that 1106 and opposite wall 1108', 1110' for extending therebetween is limited.Main body 1102 includes by rolling overTwo the parts 1102a' and 1102b' that folded portion 1109' is divided into.It is indulged as shown, folding part 1109' is arranged essentially parallel to centerExtend to axis L, wherein in this embodiment, central longitudinal axis L is arranged to pass through first part 1102a' from center.TheTwo part 1102b' can be folded towards 1114 (not shown) of the bottom side of first part 1102a' (that is, in page), so that winding is verticalThe silk of setting keeps the silk of tab 1144', 1146' that can be protected between first part 1102a' and second part 1102b'.First latch slot 1194a and the second latch slot 1194b can be formed in the first wall 1108' and the second wall 1110' respectively,To allow for second part 1102b' to be fixed on first part 1102a'.As shown, the first latch slot 1194a is substantiallyExtend perpendicular to central longitudinal axis L, the second latch slot 1194b is substantially opposite central longitudinal axis L and diagonally extends.One in part 1102a', 1102b' can reverse at the position of gap 1194a, 1194b, to allow a slot engagement anotherOne gap, to form fixed, interlocking interconnecting piece.It will be appreciated by those skilled in the art that its other party can also be passed throughFormula forms locking interconnecting piece between two parts 1102a', 1102b'.In addition, device 1100 may include institute in previous embodimentIt is some in the same characteristic features structure stated, including silk engagement of loops area 1122, for example, being located at the plug at the second end 11061124, graft receiving opening 1132, the label 1134 on the top surface 1112 of main body 1102 and silk keep featureStructure, such as the silk being vertically arranged keep tab 1144', 1146' and hole 1150a, 1152a and gap 1148a, 1154a.
The implantation material managing device 1200 of Figure 13 provides foldable with the another of at least part of device of protecting implantation materialOne embodiment.As shown, the central longitudinal axis that device 1200 has main body 1202, extends along the length of main body 1202L and top side or surface 1212 and bottom side or 1214 (not shown) of surface, wherein main body 1202 have by first end 1204,The substantially rectangular shape that the second end 1206, the opposite wall 1208,1210 extended between two ends 1204,1206 limitShape.As shown, main body 1202 includes two part 1202a " and 1202b " being divided by folding part 1226,1226 base of folding partExtend on this perpendicular to central longitudinal axis L.Second part 1202b " can be folded towards bottom side 1214 (that is, in page), so thatThe second end 1206 is closely located to first end 1204.First latch slot 1294a can be the of first part 1202a "It is formed in each of one wall 1208 and the second wall 1210, and the second latch slot 1294b can also be in second partIt is formed in each of first wall 1208 and the second wall 1210 of 1202b ".Latch slot 1294a, 1294b can be similar toThe mode of latch slot 1194a, 1194b of device 1100 operates, thus in first part 1202a " and second part 1202b "Between form the interconnecting piece of fixed interlocking.Therefore, second part 1202b " can protect the bottom for being stored in first part 1202a "Any silk on side 1214.Feature structure, such as implantable retainer 1216', graft receiving opening 1232 including plug1224 and opposite opening 1230 silk engagement of loops area 1222, the first label 1234 and the second label 1236, and guidance mark(such as image 1286 of arrow 1262' and implantation of ligament object), can be similar to feature structure those of described before.
Device 1200 further includes that silk keeps feature structure.In an illustrated embodiment, it includes terminating that silk, which keeps feature structure,In the gap 1248 being centrally located in the hole 1250 being centrally located, and the second of neighbouring implantable retainer 1216' is placed in the middleThe hole 1251 of setting.As follows to be described in detail for Figure 14 B, hole 1251 can be used in combination with silk managing device 1400, to helpKeep extra silk.Gap 1248 and hole 1250 can be as more to assist in keeping in used for the mode as described in other embodimentsRemaining silk and extra Si Chaosi is kept into feature structure guidance, it is by by hole 1251 and figure that wherein silk, which keeps feature structure,The silk managing device 1400 of 14B is used in combination and is formed.In alternative embodiment, extra silk can be only by gap 1248It is kept with hole 1250 and/or extra silk can be arranged between first part 1202a " and second part 1202b "When keep it is relatively free.
Although the illustrated embodiment of implantation material managing device is described as having rectangular shape, the technology of this fieldPersonnel will recognize that, other shapes can be used to include various feature structures provided in this article.In addition, presented hereinAny and whole implantation material managing device can be made of a variety of different materials.In some exemplary embodiments, implantation materialManaging device is formed by polyme, such as polyolefin or high density polyethylene (HDPE), because these materials have waterproofness.It can be used for shapeOther non-limiting examples at the material of implantation material managing device include metal, the material based on paper (for example, cardboard, cardboardPlate) and biocompatible material.Optionally, one or more waterproof materials can be coated in implantation material managing device.It is used to form plantA kind of exemplary, non-limitative method for entering object managing device is punching polythene strip.The weight of implantation material managing device itself canWith about in the range of about 0.05 ounce to about 1.0 ounces.This weight can provide required in the graft preparation stageStability.Further, it is possible to use a variety of different technologies and material type mark in implantation material managing device or with its other partyFormula provides label, instruction or other marks.By way of non-limiting example, for providing the technology of mark, instruction or other labelsIt may include with ink print, etching, embossing, and offer laser mark.For including the implementation of printing in implantation material managing deviceFor example, various ink, including anti-ink can be used, such as derived from Marabu GmbH&Co.KG's (Tamm, Germany)9802 PART EPOXY of Tampapur TPU ink or other medical grades ink and/or bio-compatible ink.
Silk managing device
Figure 14 A shows an exemplary embodiment of managing device 1300, can in conjunction with it is provided herein or itsHe is well known in the art the use of implantation material managing device.The device can be used for the silk for keeping extending from implantation material, andIt is aligned with the end of implantation material silk, allows to each item silk movement and/or is trimmed to required length.
The silk managing device 1300 of Figure 14 A has generally circular main body 1302, and has top surface 1312 and bottom1314 (not shown) of surface.Device 1300 can also include gap 1348, extend to from the periphery of main body 1302 and be located at circleThe hole 1350 of the approximate center of main body 1302.Can be by silk, adjustable branch 1315a, 1315b as shown, leading sutureBranch 1316a, 1316b of line 1316, and branch 1318a, 1318b of hangover suture 1318, across gap 1348 and setIt sets in hole 1350.Then the branch of 1300 movable wire of silk managing device can be used and/or trimmed to complementary length.MutuallyThe length of benefit can refer to equal length, or can refer to required unequal length, this is depended, at least partially, on and silkThe silk that managing device is used together and the type of surgery using the silk.For example, needing to extend from implantation material main body in userAll silks all there is equal length in the case where, silk can be tensed, and device 1300 can be made along the running lengthwise of silk,Until end of the device 1300 close to silk at required length.Then silk can be trimmed to required length.
In device 1300 for that can separate device 1300 with silk in the case where trimming filament length degree.Alternatively, device 1300It can keep associated with silk, such as by making it is easier to track each item silk and by preventing them from becoming to tangle to helpManage silk.In some embodiments, can be provided at least one of top surface 1312 or bottom surface 1,314 one orMultiple guidance marks, to notify user that silk associated with implantation material can be arranged in hole 1350.For example, can be at topAdjustable branch 1315a, 1315b, branch 1316a, 1316b of leading suture 1316 are formed on surface 1312, and are draggedThe diagram of branch 1318a, 1318b of tail suture 1318.
It can be related to silk managing device 1300 by silk before it implantation material will be removed from implantation material managing deviceConnection.Therefore, silk managing device 1300 can keep previously silk associated with the silk of implantation material managing device holding feature structure.When implantation material is moved to patient's body from the position (such as position of graft preparation device) for being prepared for implantation of ligament object,This can prevent silk from becoming to tangle or damage.Then can will silk be arranged in vivo before by silk managing device 1300 withSilk separation.Alternatively, silk managing device 1300 can be used one section when implantation material is still associated with implantation material managing deviceTime.For example, user can still be connected to implantation material managing device in implantation material or otherwise fill with implantation material managementComplementary branch length is formed when setting associated using silk managing device 1300.
Device 1400 shown in Figure 14 B provides the different non-limiting examples of the optional configuration of a managing device.In one exemplary embodiment, device 1400 can be used with integrated implant managing device 1200.
As shown, device 1400 is with generally circular main body 1402 and has top surface 1412 and bottom surface1414 (not shown).Device 1400 can also include the hole 1450 of the approximate center positioned at circular body 1402.Hole 1450 canIt is configured to cooperate with the hole 1251 of implantation material managing device 1200, so that top surface 1412 is roughly parallel to top surface1212.Although those skilled in the art, which will recognize that, can be used for silk managing device 1400 and implantation material managing device 1200The various parts of cooperation, but in one exemplary embodiment, cylindrical grommet (not shown) can be arranged in two devices1200, between 1400, wherein the corresponding hole 1251,1450 of device 1200,1400 receives the opposite base portion of grommet.GrommetBase portion can be open or closure.Resulting configuration can be similar to spool, and wherein device 1200,1400 is used as the end of spoolPortion, the cylindrical wall extended between two base portions of grommet, which is used as, can surround its surface that extra silk is arranged.
Second hole 1452 can also pass through main body 1402 and be formed, far from center a distance.It gap 1454 can be from circleThe periphery of main body 1402 extends to the second hole 1452, to provide for silk to be penetrated to the inlet point in hole 1452.It can be byTwo holes 1452 make it is easier to track each item silk and prevent silk from becoming to tangle to help to manage silk.For example, plant can will be centered aroundThe end for entering the silk of the grommet winding extended between object managing device 1200 and silk managing device 1400, passes through gap 1454 and is arrangedInto hole 1452.Compared with when hole is centrally located, deep second hole 1452, so that penetrating in hole 1452 and inciting somebody to action silkSilk takes out from hole 1452 to be become to be more easier, because silk has shorter travel distance at this time, when silk is in gap 1454A possibility that being stuck in gap 1454 when middle traveling is lower.It is similar with device 1300, it in some embodiments, can be at topOne of surface 1412 and bottom surface 1414 or both are upper to form one or more marks, with the feature of instruction device 1400The specific purposes of structure.
The size and shape of device 1300,1400 are designed to size and shape with implantation material managing device and implantation materialShape is complementary.Any material for suitably forming implantation material managing device is also suitable for forming a managing device 1300,1400.With device1400 grommets being used in combination, or the other component similar with grommet purposes, can be by suitably forming appointing for implantation material managing deviceWhat material is formed, including but not limited to metal or plastics.
Surgical implant is attached to implantation material managing device
Figure 15 A-15S is shown for implantation material managing device (device 900 as shown in Figure 10 A) to be placed on compact structureAn exemplary embodiment in type.As shown in fig. 15, device 900 can be had using flat, punching configuration in Qi DingThe label 934,936 and graft receiving opening 932 that are formed on portion surface 912, opposite opening 930, alignment opening 940,And wherein forming multiple holes 950,954 (Figure 15 B) and (figure of gap 938,948,954 for being used as silk and keeping feature structure15B),958,960.Implantable retainer 916 is used to form a folding part for the plug in engagement of loops area 922 924 926, is horizontalThe silk of setting keeps tab 944,946, and keeps tab 956, and when beginning can be unfashioned configuration.
As shown in fig. 15b, the bottom surface 914 of second part 928 towards main body 902 can be folded, as shown in figure 15 c, andAnd the second end 906 can be arranged in keeping gap 938.Resulting configuration is shown in Figure 15 D, and wherein second part 928 is protectedIt holds in the appropriate location adjacent with bottom surface 914, so that the label when checking bottom surface 914, on second part 928936 are visible.In addition, graft receiving opening 932 and opposite opening 930 form the plug 924 in silk engagement of loops area 922.When they are in compact configuration, the new end of main body 902 is also formed.
As shown in Fig. 15 E, formed implantable retainer 916 opposite tab 918,920 (in the view of Figure 15 E,920 be hiding) it can be bent or be folded, so that they are no longer neat with the plane that extends substantially across top surface 912It is flat.Figure 15 E shows the tab 918 bent far from main body 902 towards top surface 912 (opposite with towards bottom surface 914).It can be withOther tabs 920 are bent towards top surface 912 with similar mode.
Horizontally disposed silk keeps tab 944,946 that can also be bent or folded so that they no longer with substantially prolongExtend through the planes align of top surface 912.As shown in fig. 15f, the second tab 946 can be at the first folding part 946b towards topPortion surface 912 is (opposite with towards bottom surface 914) to be folded, to leave above-mentioned plane.It then can be by tab 946 along foldingPortion 946b is towards the downward replication of bottom surface 914, so that tab 946 is ultimately disposed at below bottom surface 914.In alternative implementationIn example, tab 946 can be only bent downwardly towards bottom surface 914.It can also be by the second tab 946 in the second folding part 946cPlace is turned back towards main body 902, as shown in Figure 15 G.Therefore, the end 946e of tab 946 can be substantially parallel to above-mentioned plane, such asShown in Figure 15 H.Figure 15 F-15H also shows that these identical flexures or folding strategy are suitable for the first tab 944.
The holding tab 956 being arranged in the first wall 908 can also bend or fold, so it is configured at least partlyGround is arranged around silk.Figure 15 I is shown, can by tab 956 along the folding part 956c being more centrally located towards top surface 912It folds.Then tab 956 can be turned back along the second folding part 956b towards main body 902, as shown in Figure 15 J.This is resulted inThe sleeve that silk can be disposed therein, as described herein.
After all foldings and bending are completed, implantation material managing device 900 can look like dress as shown in figure 15kIt sets.It will be appreciated by those skilled in the art that forming each step of the configuration in the case where not departing from disclosure spiritIt can usually execute in any order.Therefore, by non-limitative example, horizontally disposed holding tab 944,946 can beIt keeps being formed after tab 956, alternatively, being formed before folding second part 928 towards bottom surface 914.
Figure 15 L is shown the implantation material 10 of Figure 1A one kind for starting step associated with implantation material managing device 900Selection.As shown, ring 14 is arranged around plug 924, the remainder of implantation material 10 is mobile towards first end 904.It keepsAll alignment of ring 14 are helpful, because so, ring will not wind or intersect, and they can each self-forming graftThe frame of receiving opening 932, as Figure 15 M is shown more clearly.
Figure 15 M is also shown and the tab 918 of implantable retainer 916,920 associated implantation material main bodys 12.It canWill be bent closer to the tab 916 of 0 millimeter of mark line towards the second wall 910, to allow main body 12 from passing through below, then may be usedBy it towards 902 replication of main body, to help for be fixed on device 900 one end of main body 12.It then can be by other 920 courts of tabFirst wall 908 flexure, then in the setting of main body 12 in its lower section later by it towards 902 replication of main body, to help main body 12The other end is fixed on device 900.The end of main body 12 associated with closer tab 918 may be typically located at about 0At millimeter mark line, so that (such as) is when user is labeled on top surface 912 or ring 14, assist in ensuring that accuratelyIt uses.As shown in Figure 15 N, the silk extended from the top side 12t of main body 12 can be tensed (that is, adjustable branch 15a, 15b, precedingSeam guide zygonema 16 and hangover suture 18), to determine fixation position of the implantation material main body 12 relative to device 900.
It, can be by adjustable branch 15a, 15b and preceding seam guide after 916 stationary body 12 of implantable retainerZygonema 16 and hangover suture 18 pass through center gap 948 and are inserted into and are arranged in hole 950, and wherein gap 948 terminates at hole 950Place, as shown in Figure 15 O.Tension can be applied to each of branch 15a, 15b and suture 16,18, it is loose to ensureSilk will not interfere the observation to top surface 912 and implantation material 10.Keep tense when, as shown in Figure 15 P, can by branch 15a,15b and suture 16,18 wind horizontally disposed silk and keep tab 944,946.More particularly, can by branch 15a, 15b andSuture 16,18 winds reception area 944r, 946r of tab 944,946, surplus until branch 15a, 15b and suture 16,18Remaining part point is at required length.Figure 15 Q show branch 15a, 15b and suture 16,18 at required length one showsExample, wherein the remainder of silk 15a, 15b, 16,18 can keep feature structure to keep by other silks, but remainder cannot be tooLong, otherwise extra silk will interfere user.In one exemplary embodiment, it guides by remainder to other silkBefore keeping feature structure, silk 15a, 15b, 16,18 are wound with about three whole circles around tab 944,946.
It, can be by branch 15a, 15b and suture 16,18 towards the gap 954 that formed in the first wall 908 as shown in Figure 15 RIt is mobile.Branch 15a, 15b and suture 16,18, which can pass through gap 954 and enter, would be held in hole 952 therein.ThenThe redundance of branch 15a, 15b and suture 16,18 can be made to promote towards holding tab 956.As shown in Figure 15 S, keep prominentPiece 956 can engage branch 15a, 15b and suture 16,18, their position is fixed with the edge along main body 902.BranchThe redundance of 15a, 15b and suture 16,18 can extend from holding 956 Chao Si engagement of loops area 922 of tab, but it is preferred thatThe amount of redundance is insufficient to interfere with user to the preparation process of the observation of top surface 912 or interference surgical operation.
User can execute in some position (for example, operating room) for method described in Figure 15 A-15S, alternatively, canImplantation material 10 and implantation material management to be filled at manufacturing facility before the combination of transportation and packaging device 900 and implantation material 10900 are set to be associated together.In addition, it will be appreciated by those skilled in the art that can be by various other methods according to this paper instituteThe disclosure of offer is associated with implantation material managing device by implantation material, and the method depends, at least partially, on implantation property managementManage the configuration of device and implantation material, and the type of surgery using implantation material managing device and implantation material.
Graft preparation device
Once implantation material is connected to implantation material managing device, so that it may prepare implantation material managing device combination graftDevice or plate use, to assist to measure.Graft preparation device is generally known to those skilled in the art, therefore hereinOnly provide the general remark to such device.As shown in figure 16, graft preparation device 2000 may include platform 2002, platform2002 have the first holding element 2004 and the second opposite holding element 2006 extended from platform 2002.Holding element2004,2006 may be generally configured to clamping implantation of ligament object 3000 opposite end 3000a, 300b.Implement shown inIn example, holding element 2004,2006 respectively includes the jaw of end 3000a, 3000b for clamping implantation of ligament object 30002008,2010 and 2012,2014, but can also be with various other technologies relative to 2000 ligament graft fixation object of preparation device3000 position.Tension element 2016 can be with 2004 mechanical engagement of the first holding element, and it can be operably byMake the first clamping element 2004 along the length linear displacement of platform 2002 and provides tension to implantation of ligament object.As shown,Sliding thread spindle 2018 can extend between tension element 2016 and the first holding element 2004, to assist linear displacement.It canLabel 2020 is provided on platform 2002, to help to read the length of implantation of ligament object, or in the enterprising rower of implantation of ligament objectInfuse or mark indicator.Other details related with graft preparation device mention in the United States Patent (USP) 6,796,977 of Yap et al.For the content of the patent, which is incorporated by reference, to be incorporated herein.
It is quasi- that Figure 17 A and 17B show the graft used in conjunction with the implantation material managing device 900 and implantation material 10 of Figure 15 SThe alternative embodiment of standby device or plate 2000'.Graft preparation device 2000' may include platform 2002' and extending therefromFirst holding element 2004' and the second holding element 2006'.As shown, the first holding element 2004' includes tough for clampingJaw 2008', 2010' with graft 3000', the second holding element 2006' includes being configured to receive implantation material management dressSet the column 2022' of 900 alignment opening 940.As shown, implantation of ligament object 3000' is arranged across graft receiving opening 932And it is therefore connected to ring 14, it can extend from implantation material managing device 900 towards the first holding element 2004'.Implement shown inIn example, the curtailment of implantation of ligament object 3000', therefore can be by suture 3002''s to reach the first holding element 2004'On one or more free branch's eyelets to two ends 3000a', 3000b' of implantation of ligament object 3000'.Then it can will sutureLine 3002' winds the first holding element 2004', relative to the fixed suture 3002' of the first holding element 2004' and to ligamentGraft 3000' applies tension.Tension element 2016', which is provided by sliding thread spindle 2018' to the first holding element 2004', to be openedPower, and tension is moved to implantation of ligament object 3000' by suture 3002'.When implantation of ligament object 3000' moves away from columnWhen 2022', the tension in implantation of ligament object 3000' increases.It will be appreciated by those skilled in the art that can be by various otherMethod is associated with graft preparation device by implant device 900 and implantation of ligament object 3000', to provide required tension.
As seen in this fig. 17b, due to the configuration of implantation material managing device 900, and specifically on top surface 912The label 934,936 of offer, so when providing required tension to implantation of ligament object 3000', it can be in device 900, implantationObject 10, for example, indicator is labeled or marks on ring 14 and/or implantation of ligament object 3000', without relying on individually measurementInstrument, the ruler or label such as formed on graft preparation device.Then surgeon can make in surgical proceduresValuable feedback related with implantation material 10 and graft 3000' is provided with indicator.It can actually be by device 900Second part 928 reverts to deployed configuration, allows for measurement relevant to implantation of ligament object 3000', as shown in the figure.
It will be appreciated by those skilled in the art that can be used the setting based in part on the device used and intoCapable type of surgery carries out a variety of measurements and marks relevant indicator.By way of non-limiting example, in some surgical operationsIn (such as ACL reparation), can forming tool, there are two types of the tunnels of different-diameter.Implantation material 10 can be configured to smaller straightThere is final implantation object location in the tunnel of diameter, and implantation of ligament object 3000' can have most in larger-diameter tunnelImplantation object location eventually.User can measure the depth in tunnel, and come marking ring 14 and implantation of ligament object using label 934,9363000', so that user knows when implantation material 10 and implantation of ligament object 3000' are located at required position.Below for Figure 18 A-18F provides the working example for the measurement type that can be carried out in ACL repair process.
ACL reparation is carried out using the indicator marked on implantation material and implantation of ligament object
It as shown in Figure 18 A, can be by necessary tunnel 4020,4022 being formed in femur 4002 and shin bone 4004 come quasi-The ACL prosthesis of standby knee 4000.These tunnels can be formed with technology well known by persons skilled in the art.Femoral bone tunnel4022 may include main channel 4024 and walk channel 4026, wherein walk channel 4026 have it is more lesser than main channel 4024 straightDiameter.Tibial tunnel 4020 being located so as to, the component passed through from tibial tunnel 4020 can easily pass through shin bone 4004 and stockJoint space 4006 between bone 4002, and enter the main channel 4024 of femoral bone tunnel 4022.
The depth in each tunnel can be measured, and by implantation material managing device, implantation material 10 and implantation of ligament objectIndicator is labeled or marked on any one of 3000' to indicate those measured values.In some embodiments, in implantation materialThe operation that indicator is marked on managing device, implantation material and implantation of ligament object can be carried out in conjunction with the operation for forming tunnel in bone(that is, carrying out simultaneously).This can be measured to avoid individual osseous tunnel.In addition, if first man formed osseous tunnel while,Second people marks the mark or indicator of instruction osseous tunnel depth, then can obtain more more acurrate than pervious surgical operation and moreEfficient method.
It can be in front of the upper mark indicator of at least one of implantation material 10, device 900 and implantation of ligament object 3000'Prepare these components.Although discussing some particular contents of preparation process above with respect to Figure 15 A-15S and Figure 17 A-17B,If implantation material can be usually connected on device 900, and implantation of ligament object can be prepared without packing in advance like this3000', for being connected to the ring 14 of implantation material.Any extra tissue can be removed, implantation of ligament object 3000' is cleared up, thenIt can will be on two ends 3000a', 3000b' of free branch's eyelet of suture 3002' to implantation of ligament object 3000'.It can incite somebody to actionImplantation of ligament object 3000' passes through graft receiving opening, so that the substantially central portion tap of implantation of ligament object 3000' closes implantation materialSilk ring 14, and end 3000a', 3000b' be in the opposite facing two sides of ring 14, substantially adjacent to each other.It then can be by sutureThe free branch of 3002' is connected to the first holding element 2004', and column 2022' can be open with the alignment of engagement device 900940.Tension can be applied to the free branch of suture 3002', by device 900, implantation material 10 and implantation of ligament object 3000'It is located in the suitable position for mark.
In one exemplary embodiment, the entire depth of femoral bone tunnel 4022 can be labeled in the ring 14 of implantation material 10On.The measured value can be described as total bone storage depth sometimes.In such embodiments, if the depth of femoral bone tunnel 4022 is 40 millisRice, then user can on the ring 14 far from 1240 millimeters of implantation material main body (such as the first side of ring 14 shown in Figure 18 BOn 14f and second side 14g) place one or more indicator 14d.By the way that implantation material 10 is maintained on device 900, userIndicator 14d can be marked on ring 14 by the label 934 being arranged between implantable retainer 916 and plug 924.SoSurgeon can rely on indicator 14d during surgery afterwards, as follows to be discussed in more detail.
In addition, can be by the deep annotation of main channel 4022 on implantation of ligament object 3000'.The measured value can be described as moving sometimesDepth of the plant in tunnel.In such embodiments, if the depth of main channel 4022 is 25 millimeters, user can beOn separate implantation of ligament object 3000' and 25 millimeters of contact position of the ring 14 of implantation material 10 of implantation of ligament object 3000' (such as schemeOn the first side 3000f' and second side 3000g' of implantation of ligament object 3000' shown in 18B) it places one or more marks or refers toShow symbol 3000d'.By the way that implantation material 10 to be maintained on device 900, user, which can rely on, to be arranged on second part 928Label 936 marks indicator 3000d' on graft 3000'.Then surgeon can rely on indicator in the course of surgery3000d', it is as follows to be discussed in more detail.
After marking indicator 14d, 3000d' on implantation material 14 and implantation of ligament object 3000', implantation material 10 can be made de-It is separated from implantation material managing device 900, or otherwise.It, can be by initially by implantation material 10 and device in some operations900 associated reverse orders remove implantation material 10 from device 900.Therefore, can by adjustable branch 15a, 15b, withAnd leading suture 16 and hangover suture 18 are pulled out from holding tab 956 and hole 952 and gap 954, then from levelThe silk of setting keeps unwinding on tab 944,946.It then can be by branch 15a, 15b and suture 16,18 from hole 950 and gapIt is pulled out in 948, implantation material main body 12 is removed from implantable retainer 916, and ring 14 can be pulled away from plug 924.Figure 18 BShow the gained configuration of the implantation material 10 isolated with device 900.As shown, implantation of ligament object 3000' is arranged in ring 14,Implantation of ligament object indicator 3000d' is formed on the first side 3000f' and second side 3000g' of implantation of ligament object 3000', ringIndicator 14d is formed on the first side 14f and second side 14g of ring 14.Implantation material 10 further includes the branch of leading suture 1616a, 16b, branch 18a, 18b of the suture 18 that trails and adjustable branch 15a, 15b that ring 14 can be made to collapse, as schemed instituteShow, wherein adjustable branch 15a, 15b extend to receiving portion 17a, 17b of leading suture limb 16a, 16bIn.In addition, can be associated with end 3002a', 3002b' of implantation of ligament object 3000' by the free branch of suture 3002',To help to apply tension to implantation of ligament object 3000' when using graft preparation device and in surgical procedures, andOtherwise control implantation of ligament object 3000'.
As shown in figure 18 c, it can be used and wear circumferential weld zygonema or shuttle suture 3004', to help initial drawing implantation material10 pass through tibial tunnel 4020 and femoral bone tunnel 4022.Wearing circumferential weld zygonema or shuttle suture is for those skilled in the artKnow, but in an illustrated embodiment, wears circumferential weld zygonema or shuttle suture includes first end 3004a' and the second end3004b', wherein first end 3004a' has in the ring 3006' for being used to receive silk wherein formed, and the second end 3004b'For the branch 3008' with shift(ing) ring 3006' can be caught by surgeon.It can be by leading suture 16, hangover suture 18 and canA part of each of branch 15a, 15b of adjusting are inserted into across ring 3006', are then passing through pass from tibial tunnel 4020It saves space 4006 and when into and through femoral bone tunnel 4022, advances with circumferential weld zygonema 3004' is worn.In some embodiments, it answersMake leading suture 16, hangover suture 18 and each of adjustable branch 15a, 15b approximately no more than about 7 centimetres4020,4022 are passed through tunnel with wearing circumferential weld zygonema 3004' to about 10 centimetres of parts, so that silk 15a, 15b, 16,18 will not be byIt is stuck in tunnel 4020,4022.
Once implantation material main body 12 is in joint space 4006, so that it may by leading suture 16, hangover suture 18 and canA part of each of branch 15a, 15b of adjusting are arranged across femoral bone tunnel 4022, allow surgeon from tunnelThem are caught outside road 4022.The implantation in joint space 4006 can be observed with multiple technologies well known by persons skilled in the artOwner's body 12, but in some embodiments, endoscope or other observation devices can be inserted into joint space 4006 by surgeonIn.Then can apply most tension by seam guide zygonema 16 forward to pull in implantation material main body 12 in femoral bone tunnel 4022.Meanwhile the tension holding on suture 18 and adjustable branch 15a, 15b that makes to trail is enough to be applied to them will notTension-stretched degree on leading suture 16 is helpful, because so, trail suture 18 and adjustableBranch 15a, 15b are at least tensed.Furthermore it is also possible to the implantation of ligament object 3000' for extending through tibial tunnel 4020 orThe free branch of suture 3002' associated there applies tension, and wherein tension applies along direction M, far from femoral bone tunnel4022 and mobile towards tibial tunnel 4020.Direction M is as shown in Figure 18 D, hereafter will be described in detail.
When pulling implantation material main body 12 across femoral bone tunnel 4022, it is known that implantation material main body 12 has passed through logical including walkingEntire tunnel including road 4026 is helpful, because so, surgeon is known that main body 12 is located at and to overturnOr the position of femoral cortex 4008 is otherwise abutted, to set the implantation position of main body 12.For surgeon,It may be not easy to know that implantation material main body 12 has been left and walk channel, because around the tissue and other bodies of femoral cortex 4008The resistance that part provides may look like the resistance existing when implantation material to be arranged in femoral bone tunnel 4022.In addition, canDevice such as endoscope more can be observed it is difficult to being arranged near the femoral cortex 4008 opposite with joint space 4006, becauseOrganized and other parts near femoral cortex 4008.Therefore, do not knowing whether implantation material has left femoral bone tunnel 4022In the case of, surgeon may will continue to try to pull implantation material main body 12 across femoral bone tunnel 4022, and final can find himOr her practical drawing implantation material main body 12 passes through the other parts of tissue or body, and then damage implantation material, graft and/orThe other parts of tissue or body.
However, the indicator 14d on ring 14 can solve the problem of when implantation material leaves femoral bone tunnel 4022 do not known.Entering for main channel 4024 can be observed using the endoscope being arranged in joint space 4006 or other observation devices, surgeonMouthful, to observe position of the indicator 14d relative to main channel 4024.When no longer seeing indicator in joint space 4006When 14d (because indicator 14d be arranged in main channel 4024), surgeon just know implantation material main body 10 left walk it is logicalRoad 4026, because the position of indicator 14d represents the length of femoral bone tunnel 4022.Then surgeon just knows that he or she can be withImplantation material main body 12 is overturn or is positioned in other ways against femoral cortex 4008.Although can be with known to those skilled in the artVarious technologies overturn against femoral cortex 4008 or relocate main body 12, but in the illustrated embodiment of Figure 18 D, pass through behaviourLeading suture 16 and hangover suture 18 are indulged, so that the bottom surface 12c of implantation material main body 12 is against cortex 4008.OptionallyGround, or furthermore it is possible to along general direction M selectively to implantation of ligament object 3000' applied force, to tense implantation of ligament object3000' simultaneously helps to manipulate main body 12 by " overturning " main body 12 into required position.Once surgeon is as needed for plantEnter the orientation of owner's body 12, surgeon can use various technologies (including to use from pulling leading suture 16 and hangover seamThe touch feedback that zygonema 18 and implantation of ligament object 3000' are received, and/or assisted using vision) determine implantation material main body 12Position be lie low on femoral cortex 4008, with 4022 direct neighbor of femoral bone tunnel.
Once being arranged main body 12 in its desired position, so that it may be applied along direction N to adjustable branch 15a, 15bAdd tension, to reduce the circumference of ring 14, so that implantation of ligament object 3000' associated there is pulled further into main channel 4024In.Tension can be applied in various manners, including simply pulled along direction N.In some embodiments, as shown in fig. 18e, may be usedAdjustable branch 15a, 15b are wrapped on some object (tool 3010' as shown in the figure), to help to obtain requiredPower.Downward tension can also be applied to implantation of ligament object 3000' along direction M, while applied to adjustable branch 15a, 15bTension, so that the free branch of implantation of ligament object 3000' and suture 3002' associated there will not be by too quickly along the sides NTo wrench.
When implantation of ligament object 3000' passes through main channel 4024 and towards when walking the propulsion of channel 426, it is known that implantation of ligament objectWhen 3000', which is arranged to and walks 4026 direct neighbor of channel, is helpful.Otherwise, surgeon may will continue to tryDrawing implantation of ligament object 3000' walks channel 4026, but walks channel 4026 and be not configured to usually that there is setting to existImplantation of ligament object therein.It tries to pull in implantation of ligament object 3000' and walks the meeting of channel 4026 to implantation material 10, implantation of ligament object3000' and/or knee 4000 cause unnecessary injury.
However, when the indicator 3000d' on implantation of ligament object 3000' can solve does not know implantation of ligament object 3000'The problem of with 4026 direct neighbor of channel is walked.Reuse the endoscope being arranged in joint space 4006 or other observation dressesIt sets, surgeon can observe the entrance of main channel 4024, to observe position of the indicator 3000d' relative to main channel 4024It sets.(because they are arranged in main channel 4024), surgeon when no longer seeing 3000d' in joint space 4006Just know the position of implantation of ligament object 3000' and walk 4026 direct neighbor of channel, because the position of indicator 3000d' representsThe length of main channel 4024.Surgeon is not and so knows that need further to pull implantation of ligament object 3000' across femoral bone tunnel4022, otherwise it can unnecessarily be pulled in and be walked in channel 4026.Figure 18 F is shown by being arranged on femoral cortex 4008The configuration that main body 12 and the implantation of ligament object 3000' for being arranged to and walking 4026 direct neighbor of channel are formed.
Once implantation material 10 and implantation of ligament object 3000' are fixed, so that it may rotation knee 4000 as needed, to removeExtra relaxation in system.Then, adjustable branch 15a, 15b can be retightened, to ensure implantation of ligament object 3000''sRequired position.Then it can set about fixed tibial with technology well known by persons skilled in the art.Furthermore it is possible to trim adjustableBranch 15a, 15b, so that not extra branch is arranged in surgical site.Usually should with do not sacrifice ring 14 and its with implantationThe mode of the integrality of the interconnecting piece of owner's body 12 trims branch 15a, 15b, this process is by being arranged in leading suture 16Branch 15a, 15b in receiving portion 17a, 17b are assisted.In addition, after being with advantage situated main body, it can be by preceding seam guideZygonema 16 and hangover suture 18 are separated with implantation material main body 12.It can be in such a way that they be pulled out or by cutting themIt cuts and the mode pulled out takes out them, this depends on their initially modes associated with implantation material main body 12.
MPFL is repaired
Figure 19 A and 19B show the certain portions for the MPFL prosthesis that can be carried out according to disclosure provided in this articlePoint.As shown in Figure 19 A, femoral bone tunnel 5022 can be formed in femur 5002, and wherein tunnel 5022 includes main channel 5024 and wearsRow of channels 5026, and channel 5026 is walked with than the lesser diameter in main channel 5024.It can be quasi- with manner described aboveStandby implantation material, implantation material managing device and implantation of ligament object, and the techniques described herein or those skilled in the art can be usedKnown other technologies are inserted into tunnel 5022.In one exemplary embodiment, using for described in Figure 18 A-18FTechnology implantation material 10 " and implantation of ligament object 3000' are penetrated into main channel 5024 and walk channel 5026, and make their oneIt partially passes through main channel 5024 and walks channel 5026.Can in advance by implantation material 10 " and it is as described herein or by its derivativeAny one of the embodiment of surgical implant managing device (including device 900) it is associated.
Figure 19 B provides the configuration formed in a part above with respect to operation described in Figure 18 A-18F, wherein implantation material10 " main body 12 " is against femoral cortex 5008, and adjacent with the opening walked in channel 5026, ring 14 ", which is substantially provided in, walksIn channel 5026, and graft 3000' is arranged in main channel 5024.As shown, the free branch of suture 3002' withGraft 3000' on 5000 side of knee is associated, in branch 15 " and suture 16 ", 18 " and 4000 other side of kneeImplantation material main body 12 " is associated, but in the free branch and suture 16 ", 18 " of suture 3002' at least any one can be withIt is separated with corresponding graft 3000' and implantation material main body 12 ", to complete implant surgery.In an illustrated embodiment, implantation material10 " include single adjustable branch 15 " to adjust the diameter of ring 14 " associated with ring 14 ", and leading suture 16 " includesExtend the single branch to help guide main body 12 " to pass through femoral bone tunnel 5022 from main body 12 ", hangover suture 18 " is included inAlso contribute to guiding and placing the Liang Ge branch of main body 12 " in surgical procedure.Therefore, implantation material 10 " is represented to combine and is disclosed hereinAnother non-limiting example for the implantation material that content uses.It in an illustrated embodiment, can be by by adjustable branch15 " and leading suture 16 " cutting or trimming to required length separates them with main body 12 ", and the suture 18 " that trailsIt can be kept completely separate with main body 12 ".In other embodiments, leading suture 16 " can also be kept completely separate with main body 12 ", andAnd/or person's hangover suture 18 " can also include single branch.
ACL and MPFL restorative procedure provided herein only can be used implantation material managing device 900 provided in this article and plantEnter two examples of the surgical operation of the progress of object 10.It will be appreciated by those skilled in the art that the disclosure can not departed fromBy implantation material managing device 900 and/or implantation material 10 and this paper well known by persons skilled in the art or separately in the case where essenceOther implantation material managing devices and implantation material of outer offer, are used together with other multiple surgical operations, including ligamentaum cruciatum andThe modification of ligamena collateralia reparation.Using some non-restrictive illustrative embodiments provided herein is the method for the implantation material of property in sequenceThe U.S. Patent application and sequence number No.14/103 that row number is 13/793,514, have in 167 U.S. Patent application it is disclosed,Its content, which has been incorporated by reference, to be incorporated herein.
In addition, it will be appreciated by those skilled in the art that can be in the case where not departing from disclosure essence using perhapsMore other methods specifically mark or refer in the upper mark of any one of implantation material managing device, implantation material and implantation of ligament objectShow symbol.It is not the representative when forming indicator on implantation of ligament object and them being made to disappear in the visual field by non-limiting exampleImplantation of ligament object arrived required position, but indicator can be arranged so that they are appeared in visual field when represents ligamentGraft arrived required position.In this case, the depth that main channel is marked not instead of on implantation of ligament object, can be withThe depth that main channel is marked on implantation of ligament object, in addition at a distance from femoral bone tunnel extends between tibial tunnel.Then, oneDenier indicator leaves tibial tunnel and in joint space as it can be seen that surgeon will know implantation of ligament level in required positionIt sets.In a further embodiment, indicator can be formed so that they still represent required position, but outside knee as it can be seen that becauseThis is not in joint space.It can be derivative each from disclosure provided in this article in the case where not departing from disclosure essenceOther indicator configurations of kind.
Those skilled in the art according to the above embodiments, will appreciate that more features and advantage of the invention.Therefore, originallyInvention is not limited by the content for being particularly shown and having described, but is defined by the appended claims.For example, although mentioning hereinThe embodiment of the implantation material managing device of confession is configured to be used together with the implantation material of cortex button, but various devices andIts feature structure may be adapted to be used together with other kinds of implantation material (such as all different types of suture anchors).Equally, originallyIt is open to provide some modifications of special characteristic structure, for example, implantable retainer, but those skilled in the art will recognizeKnowing other configurations also can get similar results.It therefore, can be in the feelings for not departing from disclosure essence by non-limiting exampleUsing other configurations for keeping position of the implantation material main body on device under condition, for example, main body is maintained at dress by sutureIt sets.In addition, though various features described herein structure is provided for specific position, but those skilled in the art will, it will be recognized that in many cases, in the case where that will not adversely affect to the performance of device, those feature structures can positionIn on device elsewhere.For example, some may be disposed at optional position in the gap and hole that keep for silk.Draw hereinAll publications and bibliography stated all clearly are incorporated herein by reference in their entirety.